Medically Speaking Inc.

Call (312) 337-9900 or fill out form below to schedule appointments or get more information about us!
A member of our staff will call you to confirm appointment request within 24 hours.

Medically Speaking, Inc.
1-ON-1MD LLC.
467 West Erie
Chicago, IL 60654

Phone:
(312) 337-9900
Fax:
(312) 337-9902
Email:
info@MDspeaking.com
info@1-ON-1MD.com

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General form
Women Patient History
Men Patient History
Frequently Asked Questions
HIPPA Notice

STEP 1 - Date & Time

Preferred Time:

Preferred Date:

STEP 2 - Doctor

Preferred Doctor:

In a hurry? Check the box below to request the "first available" appointment. This will automatically cancel your above preferred date and time selection.

I am requesting the first available appointment.

STEP 3 - Contact Information

Title:
* First Name:
Middle initial:
* Last Name:
* Phone Number:
Alternative Phone Number:
* Email Address:

Please briefly describe the nature of your problem:

Name of the Patient:
Date Of Birth:
E-Mail:
Name of the Medicine:
Dose:
How often:
Name of the Pharmacy:
Address of the Pharmacy: (optional)
Phone number of the Pharmacy:
Fax number of the Pharmacy:

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